Asthma is a condition that may go into remission or present differently throughout stages of life. The presence of airway inflammation remains a consistent feature.
Symptoms of asthma are preventable and manageable with lifestyle modification and, when needed, medication therapy.
To achieve optimal outcomes, the MTM consult process must include patient education on trigger avoidance and self-management techniques.
MTM providers should assess use of inhaler(s) and device(s) during each visit to optimize technique and ensure maximal efficacy of asthma pharmacotherapy.
Asthma is a disease characterized by airway inflammation and obstruction. In individuals with a genetic predisposition, the airways become inflamed and hyperresponsive when exposed to various environmental triggers, resulting in bronchoconstriction, formation of mucus plugs, and airway obstruction. Common symptoms of asthma include cough, dyspnea, wheeze, and chest tightness. Asthma is one of the most common chronic diseases, with an estimated 300 million individuals affected worldwide.1, 2 Although a common health condition, the clinical presentation may be highly variable due to the intrinsic nature of the disease. Thus, global measures were created to assist clinicians in disease state management (Table 13-1).
Table 13-1.Overview of Global Measures of Asthma Assessment1 |Favorite Table|Download (.pdf) Table 13-1. Overview of Global Measures of Asthma Assessment1
|Assessment and monitoring are linked to the concepts of severity, control, and responsiveness to treatment |
Severity: intrinsic intensity of the disease process; Initial assessment of severity is measured when a patient is first diagnosed, ideally prior to receiving long-term control therapy
Control: degree to which the goals of therapy are met with minimal asthma symptoms, functional impairment, and risks of untoward events
Responsiveness: the ease with which asthma symptoms are controlled by therapy
Both severity and control include the domains of impairment and risk*
Impairment: describes the frequency of symptoms and subsequent functional limitations the patient is experiencing or recently experienced
Risk: the likelihood of asthma exacerbations, progressive decline in lung function, or adverse effects from medication
For asthma patients who are not currently taking a long-term controller medication (also known as maintenance medication), symptom severity is assessed using the impairment and risk domains illustrated in Table 13-2. To determine whether a patient is presenting with intermittent, mild, moderate, or severe asthma impairment, the following factors are reviewed: nighttime awakenings, use of short-acting bronchodilator for quick relief of acute symptoms, work days missed, patient ability to engage in normal daily activities, and quality of life assessments. In general, patients are considered at higher risk for uncontrolled asthma if they have a history of 2 or more asthma exacerbations requiring treatment with oral corticosteroids. Patients who ...